Studies on Headache: Mechanisms of Chronic Posttraumatic Headache*

Abstract

It is likely that with the exception of those headaches associated with post-traumatic subdural hematomata and subarachnoid hemorrhages, the chronic headache following trauma to the head results mainly from noxious stimuli originating on the outside of the skull. Such headaches result from sustained contraction of the skeletal muscle of the head and neck associated with the occurrence of sustained resentment, anxiety, frustration, tension, and fear, and are sometimes augmented by noxious stimuli arising from abnormal healing and scar formation within these extracranial soft structures of the head and neck. In many instances the amount of muscle contraction is minimal and probably is the basis of complaint because it is sustained and because of an abnormal preoccupation with the head. Since all of the patients in this study gave evidence of emotional disturbance, it is likely that they over-react to minimal head sensations which would otherwise be disregarded. In a small proportion of patients with post-traumatic headache, distended cranial vessels are the source of noxious stimuli which give rise to the headache. Such headaches resemble migraine headaches in quality, mechanism and response to ergotamine tartrate. Vertigo, listing, pallor, sweating, nausea, and pulse changes which accompanied the post-traumatic headache and which were induced by sudden change in position or movement of the head were experimentally reproduced and studied. It is inferred that they were the effects of spread of excitation within the brain stem resulting from noxious stimuli arising in the skeletal muscle and their attachments at the base of the skull. Scotomata, associated with post-traumatic headache, were also experimentally reproduced and studied, and are considered to be due to spread of excitation within the cerebral cortex, secondary to noxious stimuli arising in skeletal muscle about the head. Chronic headaches, which follow trauma to the head, closely resemble, as regards the basic patho-physiological mechanisms and symptomatology, other headaches which accompany and follow stress and untoward life situations but which are unrelated to head trauma.